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Managed Care Analysis

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“Managed Care is a health care delivery system organized to manage cost, utilization, and quality (Medicaid, n.d).” Managed care is set up for easy affordable access to healthcare, the care is regulated so that needed procedures are performed on the patients within the limits of network providers available. There are many undesirable and helpful aspects of managed care. For example, a managed care system provides lower costs, quality service, employer opportunities to make available insurance for their employees, in network provider connections allowing for easy finds of doctors for the patient’s specific plan (Cyrene, n.d). There are however many disadvantages, those include not having the accurate provider or lack of provider for the required …show more content…

Over the years, the services of the hospital grew and Dr. Shadid was able to expand the practice, more locals have joined the membership and companies started joining as well to provide care for employees in the community. Over the years between the 1930’s and 1960’s many other Group Health Care plans started to come around including Group Health Association in Washington, DC, Kaiser-Permanente Medical Program Health Cooperative of Puget Sound in Seattle, Health Insurance Plan of Greater New York, Group Health Plan of Minneapolis among many others, although these came with many disapprovals the number of enrolled began to rise greatly (National Council on Disability, 2013). Today those plans are known as HMO, Health Maintenance Organization which are care plans to promote prevention of illness. In 1973 Health Maintenance Organization Act was implemented by the Nixon Administration to control growth of healthcare costs and create a more widespread plan, but this plan also introduced a for profit health care industry unlike it’s not-for-profit original stance (National Council on Disability, 2013). Ongoing grown of health care and costs then had congress authorize Medicare payments for patients, meanwhile the health coverage created growth in the healthcare field itself with more in and outpatient practices being opened for operation (National Council on Disability,

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In Canada, Medicare allows people to sign up with the provincial government by a lone, administratively effective entry point in each region. This system recognizes the jeopardy of “skimming” and has had the idea to create legal restrictions to health care providers to avoid the rejection of patients. On the other hand, in the United States, large profitable corporations that become very successful with their range of services, reduce the competition. This results in people having less of a choice when it comes to their own healthcare. Canadian health care for the last 30 years has provided widely assessable health care to the people, and bringing in American managed care will only reduce accessibility to the

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The Patient Protection and Affordable Care Act (ACA) approved the use of Accountable Care Organizations (ACOs) to provide protection, value of care and reduce health care costs in Medicare. The ACO program is a charitable program which began on January 1, 2012. An ACO represents a group of providers and suppliers of services such as hospitals, physicians, and those involved in patient care. These individuals have agreed to work together to coordinate care for the patients they serve under the original Medicare. The objective of an ACO is to provide continuous, high quality care for Medicare beneficiaries, simultaneously improve quality and lower costs.

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The Accountable Care Organizations are a coordinated effort between healthcare providers to ensure the best quality of care delivered to the patients and at the same time at a reduced cost. This means that health care providers will voluntarily come together to form the ACO and patients will be able to get treated by any provider in the organization. Apart from that, it will reward the providers for delivering quality care. Even though the ACOs is comparatively a new concept, but its certain concepts and features are closely related to early managed care organizations (Barnes et al.,2014). Both MCOs and ACOs rely on the creation of physician network, promotion of member health and resource management to control costs.

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Managed Care plans are also known as prepaid health care plans. Managed healthcare plans strive to deliver high-quality healthcare, while controlling cost. Services and fees are negotiated with healthcare providers and facilities to provide access to otherwise expensive healthcare services to patients. Services under listed within the Managed Care plan monitored continuously to ensure that all services are provided in the most cost effective manner. An HMO or Health Maintenance Organization is an example of a Managed Care Plan.

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You have now learned that there are various forms of Managed Care Organizations. As a purchaser of health insurance, which form is more appealing to you? Discuss the pros and cons of your choice. Please provide specific, referenced examples in your discussion.

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Some variability differs with the capability of providing out-of-network health providers and the services in which can be provided. By having a broad range of choices that can be provided, will cause a higher the cost for the individual that is paying. Most Medicare patients have received the managed care plans due to promises of a lower copayment amount and often medication benefits. Medicare post-acute spending has grown rapidly with the number of users between 1999 and 2007. The growth in Medicare short-term post-acute service use, in part, reflects short hospital stays and a growing demand for rehabilitation services.

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The expansion of Medicaid through the implementation of the Affordable Care Act (ACA) has initiated many states to try innovative ideas to improve their Medicaid programs. Many states, like Minnesota, had started the reform process prior to the passage of the ACA with the purpose of improving the quality of care for Medicaid beneficiaries and to utilize a more cost-effective system to provide Medicaid benefits. One of the innovative ideas that states like Minnesota is implementing is the use of accountable care organizations (ACOs). This paper will explore ACOs by studying the reforms within the Minnesota Medicaid program. Background Medicaid was originally established by the government to provide medical services and payment for individuals

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It is the classic example of market failure. All in all, government intervention in healthcare is due to the government intervention itself. These interventions include the patent law which deliberated to advocate innovative activity and licensure which is intended to maintain minimal standards of quality. All these contribute to the monopoly power that dominates the whole market as well. The specific person or enterprise manages to control the whole market since they are the only supplier of a particular commodity.

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